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 |