| NPI | 1295248102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00711100) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY P08686) |
| 103TC0700X Psychologist, Clinical (Licence: NY 023960) | |
| Enumeration Date | 2017-11-14 |
| Last Update Date | 2026-02-05 |