| NPI | 1093940058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 4651) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 017686) |
| Enumeration Date | 2009-05-20 |
| Last Update Date | 2016-04-24 |