NPI | 1316030901 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY16775) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY16775) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2012-12-18 |