| NPI | 1437673779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00717800) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 022229) |
| Enumeration Date | 2017-07-28 |
| Last Update Date | 2023-07-05 |