| NPI | 1124122767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA psy7209) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA psy7209) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2007-07-08 |