| NPI | 1700022399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00594800) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS016537) |
| Enumeration Date | 2009-01-02 |
| Last Update Date | 2022-11-29 |