| NPI | 1376078030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 023688) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 023688) |
| Enumeration Date | 2017-05-01 |
| Last Update Date | 2023-04-25 |