| NPI | 1245426006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS005263L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DE B1-0000821) |
| 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00267400) | |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2012-03-21 |