| NPI | 1730507013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TF0200X Psychologist Forensic (Licence: NY 20016) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: NJ 5237) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2014-04-02 |