| NPI | 1336795509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00631200) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY10540) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS020137) | |
| 103TC0700X Psychologist, Clinical (Licence: MD 07284) | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2024-09-25 |