| NPI | 1952424384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NY 14351) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: PA 15377) |
| 103TC0700X Psychologist, Clinical (Licence: PA 15377) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: PA 15377) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2013-11-22 |