NPI | 1205918745 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA psy9979) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA psy9979) |
Enumeration Date | 2006-10-20 |
Last Update Date | 2007-07-08 |