| NPI | 1093886210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00436400) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 005016) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2007-07-08 |