| NPI | 1912062704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY5960) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY ny011875-1) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2022-03-18 |