| NPI | 1215437025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NJ 35SI00587200) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00587200) |
| Enumeration Date | 2018-02-19 |
| Last Update Date | 2018-07-16 |