| NPI | 1477094845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NJ 35SI4706) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NY 021602) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NJ 35SI4706) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 021602) | |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2017-03-17 |