| NPI | 1023525227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 023127) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00628500) |
| Enumeration Date | 2018-01-09 |
| Last Update Date | 2022-01-03 |