| NPI | 1821554767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 6064) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 022823-1) |
| Enumeration Date | 2019-02-15 |
| Last Update Date | 2019-07-24 |