| NPI | 1750980371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00575000) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 021679) |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2020-10-23 |