| NPI | 1548490022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 014064) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00457600) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2019-09-08 |