| NPI | 1326172537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 010917) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 2239) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2011-07-06 |