| NPI | 1194820464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00202600) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: NJ 35SI00202600) |
| 103TC0700X Psychologist Clinical (Licence: NJ 35SI00202600) | |
| 103TH0100X Psychologist Health Service (Licence: NJ 35SI00202600) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-07-08 |