| NPI | 1134244403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 0693) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 005165-1) |
| 103TC0700X Psychologist Clinical (Licence: CT 0693) | |
| 103TC0700X Psychologist Clinical (Licence: NY 005165-1) | |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2007-07-08 |