| NPI | 1649202326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 014830) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA PS8490L) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2007-07-17 |