| NPI | 1932472990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TE1100X Psychologist, Exercise & Sports (Licence: NJ 35SI00577700) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00442900) |
| 103T00000X Psychologist (Licence: NJ 35SI00577700) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NJ 35SI00577700) | |
| Enumeration Date | 2012-02-21 |
| Last Update Date | 2021-08-25 |