| NPI | 1093032690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: DE B1-0011565) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00465400) |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2026-05-06 |