| NPI | 1730582370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA TPS030244) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 020751) |
| Enumeration Date | 2014-09-26 |
| Last Update Date | 2014-09-26 |