| NPI | 1205098068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 31731) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 019900) |
| 103TC0700X Psychologist Clinical (Licence: CA 31731) | |
| 103TC0700X Psychologist Clinical (Licence: NY 019900) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA 31731) | |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 019900) | |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: CA 31731) | |
| 2080P0008X Pediatrics Neurodevelopmental Disabilities (Licence: CA 31731) | |
| Enumeration Date | 2008-07-01 |
| Last Update Date | 2020-04-09 |