| NPI | 1043320500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 355100049300493) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 3092) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |