| NPI | 1003868514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 012998) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 012998-2) |
| 103TR0400X Psychologist, Rehabilitation (Licence: NY 012998) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-07-18 |