| NPI | 1154482800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100103700) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY31307) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2023-08-14 |