| NPI | 1982179362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00618900) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 025507) |
| 103TC0700X Psychologist, Clinical (Licence: PA PS018593) | |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2023-05-08 |