| NPI | 1336296839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS002400L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00195800) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2007-07-08 |