| NPI | 1316287196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 5052) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 019551) |
| Enumeration Date | 2013-02-15 |
| Last Update Date | 2020-12-01 |