| NPI | 1003838095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY22895) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL PY7199) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-12-20 |