| NPI | 1932337581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00543800) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 020582) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NY 020582) | |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2020-10-26 |