| NPI | 1831520923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NJ 4975) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 019418) |
| Enumeration Date | 2013-11-27 |
| Last Update Date | 2013-11-27 |