| NPI | 1588265581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00250000) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS005429L) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-11-05 |