| NPI | 1336275585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ SI 01345) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 1345) |
| Enumeration Date | 2007-02-24 |
| Last Update Date | 2024-10-12 |