| NPI | 1427183201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 2293) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100018400) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2007-07-08 |