NPI | 1124158381 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00197100) |
Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS004308L) |
Enumeration Date | 2007-03-06 |
Last Update Date | 2007-07-08 |