NPI | 1851037386 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 024965) |
Additional Taxonomies | 103T00000X Psychologist (Licence: NY 024965) |
103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 024965) | |
103TC0700X Psychologist, Clinical (Licence: NY 024965) | |
103TH0100X Psychologist, Health Service (Licence: NY 024965) | |
103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: NY 024965) | |
Enumeration Date | 2022-05-08 |
Last Update Date | 2023-05-25 |