| NPI | 1982769212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: HI psy-596) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NJ 35SJ00409600) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2016-08-04 |