| NPI | 1417976820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ SI02963) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NJ SI02963) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-04-19 |