| NPI | 1194943068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 3551000) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA 381) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2013-06-06 |