| NPI | 1225437197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 35si00533500) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: NJ 35si00533500) |
| Enumeration Date | 2014-08-17 |
| Last Update Date | 2026-02-18 |