| NPI | 1346384815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS005042L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00230700) |
| 103T00000X Psychologist (Licence: DE B10000690) | |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2007-07-08 |