| NPI | 1376631754 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 004955-1) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 004955-1) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |