| NPI | 1780032052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS006844-L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100477200) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2016-05-27 |