| NPI | 1841366796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 4933) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35S100281200) |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| 103TS0200X Psychologist, School (Licence: NJ REG. CERTIFICATION) | |
| 106H00000X Marriage & Family Therapist (Licence: NJ 37F100105300) | |
| 103TC1900X Psychologist, Counseling (Licence: NJ 35S100281200) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: NJ 35S100281200) | |
| 103T00000X Psychologist (Licence: ME 1344) | |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2016-09-22 |