| NPI | 1922016963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 009637) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 009637) |
| 103TC0700X Psychologist Clinical (Licence: NY 009637) | |
| 103TF0200X Psychologist Forensic (Licence: NY 009637) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2021-02-23 |