| NPI | 1013110543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00218100) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI 868) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2007-07-08 |