| NPI | 1376676080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 4606) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NY 015428-1) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2012-02-29 |