| NPI | 1407913551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 1629) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 1629) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NJ 1629) | |
| 103TH0004X Psychologist Health (Licence: NJ 1629) | |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2007-10-16 |