| NPI | 1013386531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 27354) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TS0200X Psychologist, School | |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2026-06-24 |