NPI | 1295814150 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY8833) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 93-261633-2501) |
103G00000X Clinical Neuropsychologist (Licence: UT 93-261633-2501) | |
103G00000X Clinical Neuropsychologist (Licence: CA PSY8833) | |
Enumeration Date | 2006-11-03 |
Last Update Date | 2007-07-08 |