| NPI | 1104041664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 3874) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 3874) |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NJ 3874) | |
| 103TS0200X Psychologist, School (Licence: NJ 3874) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2011-10-13 |