| NPI | 1215256797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY18336) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY18336) |
| 103TF0000X Psychologist, Family (Licence: CA PSY18336) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY18336) | |
| 103TH0100X Psychologist, Health Service (Licence: CA PSY18336) | |
| Enumeration Date | 2010-05-24 |
| Last Update Date | 2016-05-02 |