| NPI | 1285952978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS018698) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00605900) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2023-04-21 |