| NPI | 1447328000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 8987-1) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 8987-1) |
| 103T00000X Psychologist (Licence: NY 8987-1) | |
| 103TA0700X Psychologist Adult Development & Aging (Licence: NY 8987-1) | |
| 103TF0000X Psychologist Family (Licence: NY 8987-1) | |
| 103TH0100X Psychologist Health Service (Licence: NY 8987-1) | |
| 103TR0400X Psychologist Rehabilitation (Licence: NY 8987-1) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2019-02-13 |