| NPI | 1679897607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 4759) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 018081) |
| Enumeration Date | 2010-03-19 |
| Last Update Date | 2023-01-25 |