| NPI | 1770887283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00583000) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2023-10-20 |