| NPI | 1386718062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: FL PY8749) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 011200) |
| 103T00000X Psychologist (Licence: NJ 35SI00330100) | |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2013-08-22 |