| NPI | 1831123298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 007483-1) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 007483-1) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2025-08-13 |