| NPI | 1932134087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 011687-1) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 011687-1) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2011-10-20 |