| NPI | 1912363896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 5199) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 020063) |
| Enumeration Date | 2016-01-08 |
| Last Update Date | 2023-03-07 |