| NPI | 1730258419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS005399L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ S102536) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-07-08 |