| NPI | 1518684018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS004796L) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00750000) |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2024-10-21 |