| NPI | 1215281027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 019284) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00492200) |
| Enumeration Date | 2012-10-31 |
| Last Update Date | 2012-10-31 |