| NPI | 1811036403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 012548) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 012548) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2022-08-10 |