| NPI | 1295163897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS018121) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 020263-1) |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2023-10-19 |