| NPI | 1700186210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00504800) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 019547-1) |
| Enumeration Date | 2010-10-30 |
| Last Update Date | 2014-11-03 |