| NPI | 1093924102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 5751) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ SI002337) |
| 103T00000X Psychologist (Licence: GA PSY002194) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2022-10-25 |