| NPI | 1174159412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY33388) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA 33388) |
| 103T00000X Psychologist | |
| Enumeration Date | 2020-03-18 |
| Last Update Date | 2025-12-01 |