| NPI | 1235165069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 008747) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 8747) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2023-07-05 |