| NPI | 1568180958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NJ 35SI00687800) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: PA PS019662) |
| 103TH0100X Psychologist, Health Service (Licence: NJ 35SI00687800) | |
| 103TH0100X Psychologist, Health Service (Licence: PA PS019662) | |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2024-05-17 |