| NPI | 1073221669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 022396) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00675900) |
| Enumeration Date | 2022-11-11 |
| Last Update Date | 2022-11-11 |