| NPI | 1215077706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 018261) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: NY 7398) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 018261) | |
| 103G00000X Clinical Neuropsychologist (Licence: NY 018261) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2010-02-25 |