| NPI | 1659451391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00428600) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00428600) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2022-09-30 |