| NPI | 1417166356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY4637) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: FL 4637) |
| 103G00000X Clinical Neuropsychologist (Licence: NY 016720-01) | |
| 103T00000X Psychologist (Licence: NY 016720-01) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 016720-01) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: FL PY4637) | |
| 103TC0700X Psychologist, Clinical (Licence: NY 016720-01) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2018-10-31 |