| NPI | 1396843983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ SI1706) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 006708) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2010-12-20 |