| NPI | 1013902063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 005414) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ SI03538) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2012-03-25 |