| NPI | 1821220021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 023728) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 23728) |
| 103TC0700X Psychologist, Clinical (Licence: NY 023728) | |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2023-08-23 |