| NPI | 1154666741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 5002) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NJ 5002) |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2013-07-01 |