| NPI | 1851737571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 019612) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00450700) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2019-05-08 |