| NPI | 1861546731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00717700) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY5185) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-08-27 |