| NPI | 1336254978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 010929) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 010929) |
| 103G00000X Clinical Neuropsychologist (Licence: NY 10929) | |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2023-07-05 |