| NPI | 1184839524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 884) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 884) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2016-05-17 |