| NPI | 1528354834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 35S100547800) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: NJ 35S100547800) |
| Enumeration Date | 2011-06-24 |
| Last Update Date | 2015-07-07 |