| NPI | 1730429739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: NY 16485) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: NJ 4822) |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2013-02-27 |