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 |