| NPI | 1194911982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: CA 24322) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA 24322) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 24322) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA 24322) | |
| 103TC0700X Psychologist, Clinical (Licence: CA 24322) | |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2013-07-23 |