| NPI | 1093102634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 018451) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 4877) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2015-04-21 |