| NPI | 1336295716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ SIO1574) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: PA PS004790L) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-08 |