| NPI | 1285186130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00591300) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 022527) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2019-06-28 |