| NPI | 1831443894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00608700) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: NJ 37PC00032200) |
| 103TC0700X Psychologist Clinical (Licence: PA PS016071) | |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2024-04-22 |