NPI | 1275924557 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY26611) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY26611) |
Enumeration Date | 2015-02-09 |
Last Update Date | 2016-01-05 |