| NPI | 1699926501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00449700) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016741) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2023-06-06 |