| NPI | 1164548079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY PSY05607) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY PSY05607) |
| 103TC0700X Psychologist, Clinical (Licence: NY psy05607) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY PSY05607) | |
| 103TF0200X Psychologist, Forensic (Licence: NY PSY05607) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NY PSY05607) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2011-11-15 |