| NPI | 1558903005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00652900) |
| Additional Taxonomies | 103TS0200X Psychologist, School |
| Enumeration Date | 2019-10-16 |
| Last Update Date | 2022-05-03 |