| NPI | 1841805512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: VA 0810007324) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 023778) |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2021-01-26 |