| NPI | 1477621936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 051a265) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016453) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2012-03-14 |