| NPI | 1124483565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PR 6599) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ TP# 153-128) |
| 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00597100) | |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2020-11-27 |