| NPI | 1457926420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 024319) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 6514) |
| 103T00000X Psychologist (Licence: PA 019471) | |
| Enumeration Date | 2021-05-23 |
| Last Update Date | 2022-03-07 |