| NPI | 1013285782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NJ 37PC00433400) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 019925-1) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2013-02-25 |