| NPI | 1073747507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PSO17612) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00376400) |
| 103TC0700X Psychologist, Clinical (Licence: NJ 521800) | |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2020-02-12 |