| NPI | 1730268533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist Counseling (Licence: NJ 01694) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: NY 016488) |
| 103TC1900X Psychologist Counseling (Licence: CT 002657) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2009-12-04 |