| NPI | 1821217340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 4419) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: NJ 4419) |
| 103TC1900X Psychologist Counseling (Licence: NJ 4419) | |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2014-03-10 |