| NPI | 1033126594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 2137) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 2137) |
| 103TF0200X Psychologist, Forensic (Licence: NJ 2137) | |
| 103TH0100X Psychologist, Health Service (Licence: NJ 2137) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2007-07-08 |