| NPI | 1073721189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 014844) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 014844) |
| 103TC0700X Psychologist Clinical (Licence: NY 014844) | |
| 103TC1900X Psychologist Counseling (Licence: NY 014844) | |
| 103TR0400X Psychologist Rehabilitation (Licence: NY 014844) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |