| NPI | 1467786665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS004026-L) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ SI01583) |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2010-07-14 |