| NPI | 1215947999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00189100) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS004304L) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2013-08-30 |