| NPI | 1629332358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35S100419900) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 012341-1) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2022-04-01 |