| NPI | 1639815202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00663800) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 024812) |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2023-01-31 |