| NPI | 1629295068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00472900) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ 37PC00294600) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2016-01-11 |