| NPI | 1154382380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY12143) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY12143) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY12143) | |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY12143) | |
| 103TH0100X Psychologist, Health Service (Licence: CA PSY12143) | |
| 103T00000X Psychologist (Licence: CA PSY12143) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY12143) | |
| Enumeration Date | 2006-03-29 |
| Last Update Date | 2010-07-29 |