| NPI | 1427757947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00728100) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 16703) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS019836) | |
| Enumeration Date | 2023-02-23 |
| Last Update Date | 2023-10-24 |