| NPI | 1134497852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 019325-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00498500) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2014-05-27 |