NPI | 1316589377 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY31877) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY31877) |
Enumeration Date | 2019-10-11 |
Last Update Date | 2020-07-01 |