| NPI | 1770505208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 3531) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 012304) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 012304) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 35S100353100) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2023-04-03 |