| NPI | 1922632769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 023781) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 023781) |
| 103G00000X Clinical Neuropsychologist (Licence: NY 023781) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: NY 023781) | |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2020-07-27 |