| NPI | 1770502346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NY 006984) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 006984) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2017-07-24 |