| NPI | 1487778973 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS017780) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00360200) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2022-02-07 |