| NPI | 1487808663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY DCMH 06890) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NJ 00013740) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2008-11-19 |