| NPI | 1891235354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 5782) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC 4508) |
| 103TC0700X Psychologist, Clinical (Licence: NY 017426-1) | |
| 103TC0700X Psychologist, Clinical (Licence: PA PS019784) | |
| Enumeration Date | 2017-03-03 |
| Last Update Date | 2023-11-01 |