| NPI | 1891784567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS-002988-L) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NJ 35SI00401800) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2007-09-18 |