| NPI | 1689443855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 026249) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 026249) |
| 103TC0700X Psychologist, Clinical (Licence: NY 026249) | |
| Enumeration Date | 2023-12-28 |
| Last Update Date | 2023-12-28 |