| NPI | 1982730412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00335100) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS-007773-L) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2016-02-07 |