| NPI | 1053451476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ SI01417) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ SI01417) |
| 103TR0400X Psychologist, Rehabilitation (Licence: NJ SI01417) | |
| 103TS0200X Psychologist, School (Licence: NJ SI01417) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |