| NPI | 1922181320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 2384) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 8382) |
| 103TC0700X Psychologist, Clinical (Licence: NJ 2384) | |
| 103TC0700X Psychologist, Clinical (Licence: NY 8382) | |
| 103TC1900X Psychologist, Counseling (Licence: NJ 2384) | |
| 103TC1900X Psychologist, Counseling (Licence: NY 8382) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2007-07-08 |