| NPI | 1396481271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 35SI00676600) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 024975) |
| 103TC0700X Psychologist, Clinical (Licence: NJ 35SI00676600) | |
| 103TC0700X Psychologist, Clinical (Licence: NY 024975) | |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2023-03-07 |