| NPI | 1881754836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CT 00992) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 06958) |
| 103TC0700X Psychologist, Clinical (Licence: CT 00992) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2007-07-08 |