| NPI | 1447269592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 6311) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 2817) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2022-02-15 |