| NPI | 1659432151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00500500) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SC05223200) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2018-12-04 |