| NPI | 1518254705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS017012) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00488600) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2018-08-22 |