| NPI | 1891100327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00540900) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00430400) |
| 103T00000X Psychologist (Licence: NY 020652) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2015-11-19 |