| NPI | 1740425818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 013863) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 4598) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2008-12-03 |