| NPI | 1508570722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 025471) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 025471) |
| Enumeration Date | 2023-01-11 |
| Last Update Date | 2024-02-01 |