| NPI | 1033586623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00622900) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 023232) |
| Enumeration Date | 2015-08-31 |
| Last Update Date | 2022-12-30 |