| NPI | 1780077362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NJ 35S100280400) |
| 103TF0200X Psychologist Forensic | |
| Enumeration Date | 2015-03-06 |
| Last Update Date | 2015-03-06 |