| NPI | 1235306689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 35s100449000) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35s100449000) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NJ 35s100449000) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: NJ 35s100449000) | |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2021-02-01 |