| NPI | 1427461078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA pss003487l) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ nj37pc00164400) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2014-06-10 |