| NPI | 1710949441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 010055) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 03589) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2015-02-09 |