NPI | 1003807876 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY20320) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY20320) |
Enumeration Date | 2005-11-02 |
Last Update Date | 2020-07-28 |