| NPI | 1205364635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY33820) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 0262737) |
| 103G00000X Clinical Neuropsychologist (Licence: NY 0262737) | |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY33820) | |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2024-09-30 |