| NPI | 1669825261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS018075) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00568700) |
| Enumeration Date | 2016-07-19 |
| Last Update Date | 2016-09-09 |