| NPI | 1538330451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 13860) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 13860) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 13860) | |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2017-01-31 |