| NPI | 1174926232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 5510) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 020722) |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2015-10-29 |