| NPI | 1699139923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00598900) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ tp153037) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2023-12-21 |