| NPI | 1245220227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 7574) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 007574) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2021-05-19 |