| NPI | 1376231712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 025647) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: IA 112265) |
| 103G00000X Clinical Neuropsychologist (Licence: NY 025647) | |
| 103T00000X Psychologist (Licence: NY 025647) | |
| Enumeration Date | 2023-04-25 |
| Last Update Date | 2023-12-18 |