| NPI | 1205042694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS0093766) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 009060-1) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2022-08-16 |