| NPI | 1528263001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00498100) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 019313) |
| Enumeration Date | 2007-06-15 |
| Last Update Date | 2013-02-04 |