| NPI | 1760606099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NJ 4414) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: DC PSY1000197) |
| 103TC0700X Psychologist Clinical (Licence: NY 012135) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2007-07-08 |