| NPI | 1073618070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00367600) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS008440L) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2024-08-08 |