| NPI | 1962909226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00420600) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS015040) |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2024-09-07 |