| NPI | 1366505828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ SI3313) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: DE PC-0000555) |
| 103TF0200X Psychologist, Forensic (Licence: NJ SI3313) | |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2021-08-16 |