| NPI | 1760095244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00675200) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PSY019182) |
| 103TC0700X Psychologist, Clinical (Licence: PA PSY019182) | |
| 103TC0700X Psychologist, Clinical (Licence: PA PS018582) | |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2022-11-17 |