| NPI | 1275023137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00667200) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ TP-221-A005) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2024-06-28 |