| NPI | 1477769867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS 002194) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: NJ FI-00734) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2007-07-08 |