| NPI | 1376214726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00785600) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC0700X Psychologist, Clinical (Licence: WY 790) | |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2025-08-11 |