| NPI | 1073821351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00554300) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NJ 35SI00554300) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2015-12-19 |