| NPI | 1073702536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS005965L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00489800) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2012-02-21 |