| NPI | 1265504104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 013460) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NC 3098) |
| 103T00000X Psychologist (Licence: NY 013460) | |
| 103TC0700X Psychologist Clinical (Licence: NC 3098) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2023-09-08 |