| NPI | 1023893591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NJ 864953) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NJ 864953) |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: NJ 864953) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NJ 864953) | |
| 103TC1900X Psychologist Counseling (Licence: NJ 864953) | |
| 103TS0200X Psychologist School (Licence: NJ 864953) | |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2023-08-31 |