| NPI | 1912184235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 24151) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00414000) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2013-12-17 |