NPI | 1790829042 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ NJSI01969) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA pso15275) |
Enumeration Date | 2007-02-19 |
Last Update Date | 2007-07-08 |