| NPI | 1952416083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NY 016735) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: NY 016735) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2025-04-02 |