| NPI | 1871205922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 025432) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 025432) |
| 103TC0700X Psychologist, Clinical (Licence: NY 025432) | |
| Enumeration Date | 2022-12-20 |
| Last Update Date | 2022-12-20 |