NPI | 1215363619 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 020276) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 020276) |
103TC0700X Psychologist, Clinical (Licence: NY 020276) | |
Enumeration Date | 2013-09-18 |
Last Update Date | 2016-04-29 |