| NPI | 1790924967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: MD 04589) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NJ 35S100426300) |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2014-08-21 |