| NPI | 1982687315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 0066630) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NJ 35SI00320100) |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2012-08-27 |