| NPI | 1538361845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 012125) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 012125) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: NY 012125) | |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2010-08-03 |