| NPI | 1114033792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 001011) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CT 001011) |
| 103TC0700X Psychologist, Clinical (Licence: NY 0117061) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2007-07-08 |