| NPI | 1154489243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00176500) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00176500) |
| 103TF0200X Psychologist, Forensic (Licence: NJ 35SI00176500) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2025-09-11 |