| NPI | 1518681220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00765300) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 07170) |
| Enumeration Date | 2022-09-27 |
| Last Update Date | 2025-04-15 |