| NPI | 1093939498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY10506) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY10506) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 017020) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2022-08-05 |