| NPI | 1134137631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 68-15434) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 68-15434) |
| 103TC0700X Psychologist, Clinical (Licence: NY 68-15434) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 68-15434) | |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 68-15434) | |
| 103TF0200X Psychologist, Forensic (Licence: NY 68-15434) | |
| 103TP0016X Psychologist, Prescribing (Medical) (Licence: NY 68-15434) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2016-02-26 |