| NPI | 1558617423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 4939) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 019457-1) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2012-07-30 |