| NPI | 1588255350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00600300) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ME PS2521) |
| 103T00000X Psychologist (Licence: NY 023070) | |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2023-10-15 |