| NPI | 1619977634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 35SINJ0013000) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NJ S101300) |
| 103T00000X Psychologist (Licence: NJ 35S100130000) | |
| Enumeration Date | 2005-08-01 |
| Last Update Date | 2008-06-11 |