| NPI | 1215411194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 023538) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00694400) |
| Enumeration Date | 2018-09-18 |
| Last Update Date | 2023-01-15 |