| NPI | 1083754493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00495600) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NJ 37PC00129700) |
| 101YP2500X Counselor Professional (Licence: DC PRC57) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2012-04-30 |