| NPI | 1013097138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 35SI00239000) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NJ S102390) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2019-04-03 |