| NPI | 1467597260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00640800) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 015522) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2024-10-15 |