| NPI | 1215286927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00522400) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 113-026) |
| Enumeration Date | 2012-09-10 |
| Last Update Date | 2021-10-28 |