| NPI | 1265485437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 2646) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 014309) |
| 103TC0700X Psychologist Clinical (Licence: NC 2646) | |
| 103TC0700X Psychologist Clinical (Licence: NY 014309) | |
| 103TH0100X Psychologist Health Service (Licence: NC 2646) | |
| 103TH0100X Psychologist Health Service (Licence: NC 014309) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2012-08-31 |