| NPI | 1104951599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00463500) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY203580) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2014-11-26 |