| NPI | 1629097449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35 SI 00 1299 00) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 005829-1) |
| 103TC0700X Psychologist, Clinical (Licence: NJ 35 SI 00 1299 00) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-09 |