| NPI | 1881382505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 025658) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 025658) |
| 103TH0004X Psychologist, Health (Licence: NY 025658) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: NY 025658) | |
| Enumeration Date | 2023-05-01 |
| Last Update Date | 2023-05-13 |