| 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 |