| NPI | 1740440981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NJ SI 02653) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 00088891) |
| Enumeration Date | 2008-06-11 |
| Last Update Date | 2008-06-11 |