| NPI | 1679632749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35S100396700) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NJ 35S100396700) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NJ 35S100396700) | |
| 103TF0000X Psychologist Family (Licence: NJ 35S100396700) | |
| 103TP2701X Psychologist Group Psychotherapy (Licence: NJ 35S100396700) | |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2022-09-20 |