| NPI | 1770680332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VA 0810003873) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 1703) |
| 103TC1900X Psychologist, Counseling (Licence: VA 0810003873) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2021-09-10 |