NPI | 1326161316 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00394200) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 014277-1) |
Enumeration Date | 2007-04-06 |
Last Update Date | 2014-04-04 |