| NPI | 1306984695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY6047) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA 2327) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2016-10-21 |