| NPI | 1629041165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100422900) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 015135) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2009-05-01 |