| NPI | 1821417668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 020500) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 020500) |
| 103TC0700X Psychologist, Clinical (Licence: NJ 5326) | |
| Enumeration Date | 2014-04-09 |
| Last Update Date | 2021-01-12 |