| NPI | 1023646387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 6395) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 023670) |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2021-06-03 |