| NPI | 1942219043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA 003384) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 028494) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2012-09-09 |