NPI | 1790299501 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 1358) |
Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: NJ 1358) |
103TC1900X Psychologist, Counseling (Licence: NJ 1358) | |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 1358) | |
103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: NJ 1358) | |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: NJ 1358) | |
103TC0700X Psychologist, Clinical (Licence: NJ 1358) | |
Enumeration Date | 2017-12-01 |
Last Update Date | 2022-07-27 |