| NPI | 1790754323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS019585) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 017604-1) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2022-06-27 |