| NPI | 1013971704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 012825) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 2772) |
| 103TC0700X Psychologist Clinical (Licence: NY 012825) | |
| 103TC0700X Psychologist Clinical (Licence: MD 2772) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2021-03-09 |