| NPI | 1972791820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: PA PS006535L) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NJ 37PC00215200) |
| Enumeration Date | 2007-10-04 |
| Last Update Date | 2013-02-05 |