| NPI | 1861736092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: NY 018945) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 018945) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: NY 018945) | |
| Enumeration Date | 2012-11-10 |
| Last Update Date | 2013-12-02 |