| NPI | 1396228755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 025819) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00719300) |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2023-07-25 |