| NPI | 1023002136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY7320) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY7320) |
| 103TH0100X Psychologist Health Service (Licence: CA PSY7320) | |
| 103T00000X Psychologist (Licence: CA PSY7320) | |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2018-02-06 |