| NPI | 1659730448 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 5556) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS019777) |
| 103TS0200X Psychologist, School (Licence: NJ 692207) | |
| Enumeration Date | 2016-02-22 |
| Last Update Date | 2025-01-17 |