| NPI | 1154761096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 25777) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA 25777) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2024-01-11 |