| NPI | 1689348815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00671500) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AL 2227) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2022-10-09 |