| NPI | 1174610257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 010647) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: NY 010647) |
| 103TC0700X Psychologist, Clinical (Licence: NY 010647) | |
| Enumeration Date | 2006-10-09 |
| Last Update Date | 2025-09-11 |