| NPI | 1124074174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 1624) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PSO16076) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2021-09-23 |