| NPI | 1982828836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NY 017823) |
| Additional Taxonomies | 101Y00000X Counselor |
| 103G00000X Clinical Neuropsychologist (Licence: NJ 4720) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2013-03-13 |