| NPI | 1154461549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA psy13999) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA psy13999) |
| 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A7737) | |
| 207Q00000X Family Medicine (Licence: CA 20A7737) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2007-07-08 |