| NPI | 1417183609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: NJ 35SI00482600) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: NY 0180691) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2018-01-29 |