| NPI | 1316082019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 35S100169300) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: NJ 35SI00196300) |
| 103TF0200X Psychologist Forensic (Licence: NJ 35SI00196300) | |
| 103TH0100X Psychologist Health Service (Licence: NJ 35SI00196300) | |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NJ 35SI00196300) | |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |