| NPI | 1386182459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 023992) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ NJDCATEMP-034874) |
| 251S00000X | |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2021-03-31 |