| NPI | 1912345919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: NJ 35SI00449900) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: NY 016837) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2013-06-12 |