| NPI | 1679799878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CT 754) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: NJ 1631) |
| 173000000X Legal Medicine (Licence: 21212) | |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2007-07-26 |