| NPI | 1437502432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 021697) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: NY 021697) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 021697) | |
| 103TC0700X Psychologist, Clinical (Licence: NY 021697) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: NY 021697) | |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2020-01-23 |