NPI | 1245433101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100042500) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA P5001589) |
Enumeration Date | 2007-06-07 |
Last Update Date | 2007-07-08 |