NPI | 1275658270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy15225) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA psy15225) |
Enumeration Date | 2007-03-20 |
Last Update Date | 2019-12-03 |