| NPI | 1467505800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00344400) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 012999) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2007-07-24 |