| NPI | 1861058372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00627400) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: NY 023210-1) |
| Enumeration Date | 2019-05-10 |
| Last Update Date | 2023-04-11 |