| NPI | 1356498992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY19211) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist, Clinical (Licence: NY 021202) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2021-12-06 |