| NPI | 1780053231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 022010-01) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MO 2015032101) |
| 103TC0700X Psychologist, Clinical (Licence: NY 022010-01) | |
| 202C00000X Independent Medical Examiner (Licence: NY 022010-01) | |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2020-01-29 |