| NPI | 1396721239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 4425) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016443) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2020-11-20 |