| NPI | 1215335997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 5391) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 021194) |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2024-02-27 |