| NPI | 1336181809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 7755) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00164100) |
| 103T00000X Psychologist (Licence: PA PS003804L) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2007-07-08 |