| NPI | 1740858240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 027059) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00771400) |
| Enumeration Date | 2021-06-12 |
| Last Update Date | 2025-02-21 |