| NPI | 1710062419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ 35SI00269800) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NJ 35SI00269800) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: NJ 35SI00269800) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NJ 35SI00269800) | |
| 103TF0000X Psychologist Family (Licence: NJ 35SI00269800) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |