| NPI | 1952598369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 3054) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS-006558-L) |
| Enumeration Date | 2007-09-29 |
| Last Update Date | 2007-09-29 |