| NPI | 1679637466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ SI02555) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ SI02555) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NJ SI02555) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NJ SI02555) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NJ SI02555) | |
| 103TF0000X Psychologist, Family (Licence: NJ SI02555) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2015-02-07 |