| NPI | 1134251259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TS0200X Psychologist School (Licence: NJ 3779) |
| Additional Taxonomies | 103TS0200X Psychologist School (Licence: PA 9320) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2024-10-29 |