| NPI | 1578640942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ NJ1599) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: NJ NJ1599) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2016-05-19 |