| NPI | 1235592320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 35SI00511900) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS017309) |
| 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00511900) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: PA PS017309) | |
| Enumeration Date | 2016-04-05 |
| Last Update Date | 2019-09-18 |