| NPI | 1669627477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PSO 16156) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY 00052525) |
| 103TF0200X Psychologist, Forensic (Licence: NJ 35S100457500) | |
| Enumeration Date | 2008-11-20 |
| Last Update Date | 2008-11-20 |