| NPI | 1447773544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00589000) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00500500) |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2018-03-17 |