| NPI | 1760551501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 009763) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 009763) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2016-02-15 |