| NPI | 1760829592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103G00000X Clinical Neuropsychologist (Licence: NY 022092) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2024-06-05 |