| NPI | 1063602118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 011864) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 6314) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2023-04-17 |