| NPI | 1588828875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS017209) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 019144) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2021-01-01 |