| NPI | 1073610770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 4276) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA 015409) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2024-08-14 |