NPI | 1295844280 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 6424) |
Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 006424) |
Enumeration Date | 2006-08-30 |
Last Update Date | 2007-07-08 |