NPI | 1184139776 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 022348) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 022348) |
103TS0200X Psychologist, School (Licence: NY 022348) | |
Enumeration Date | 2017-12-05 |
Last Update Date | 2022-04-30 |