| NPI | 1477594794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 016759) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 016759-1) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2013-12-13 |