| NPI | 1215026067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: GA 00633) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00098800) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2015-10-22 |