| NPI | 1477867315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00479300) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DE B1-0000837) |
| Enumeration Date | 2010-08-03 |
| Last Update Date | 2012-08-13 |