| NPI | 1801991658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 35S100302200) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35S100302200) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2009-04-22 |