| NPI | 1578842076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 3936) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 14186) |
| Enumeration Date | 2011-08-15 |
| Last Update Date | 2011-08-15 |