| NPI | 1699004028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00480600) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 018294-1) |
| Enumeration Date | 2009-12-14 |
| Last Update Date | 2015-08-26 |