| NPI | 1285235077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: NJ NJDCATEMP-031433) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CA 32192) |
| Enumeration Date | 2020-11-06 |
| Last Update Date | 2021-04-07 |