| NPI | 1295248102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00711100) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 023960) |
| 103TC1900X Psychologist, Counseling (Licence: NY P08686) | |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2023-06-29 |