| NPI | 1659305100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00299300) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00299300) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NJ 35SI00299300) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 35SI00299300) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2015-11-17 |