| NPI | 1609910256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 22571) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 017080-01) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2022-02-11 |