| NPI | 1831582170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00592000) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NJ 35SI00592000) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NJ 35SI00592000) | |
| 103K00000X Behavior Analyst (Licence: NJ 1-14-16071) | |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2024-10-12 |