| NPI | 1972931806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS-004341-L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ SI-00003704) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2013-11-01 |