| NPI | 1356390835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY7159) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY7159) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2008-09-03 |