| NPI | 1629073572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 35S100415100) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 35si00415100) |
| 103T00000X Psychologist (Licence: NJ 35S100415100) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2011-04-11 |