| NPI | 1104975440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS016826) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 016779-1) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2014-03-19 |