| NPI | 1922546720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 020819) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00556900) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2024-11-29 |