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 |