| NPI | 1154341246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS015742) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ SI02660) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2024-04-19 |