| NPI | 1114399383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00557600) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA 017910) |
| Enumeration Date | 2015-10-27 |
| Last Update Date | 2024-12-03 |