| NPI | 1033247226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NH 1298) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 68 018046) |
| 103TC0700X Psychologist, Clinical (Licence: NY 68 018046) | |
| 103TC0700X Psychologist, Clinical (Licence: NH 1298) | |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2020-03-06 |