| NPI | 1295191294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00594500) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS017989) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: PA PS017989) | |
| Enumeration Date | 2016-01-06 |
| Last Update Date | 2018-08-01 |