| NPI | 1114178985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 21995) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY21995) |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY21995) | |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2015-05-05 |