| NPI | 1104904499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 010456-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00312100) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2019-08-27 |