| NPI | 1629236781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 017282-1) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 017282-1) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2009-11-11 |