| NPI | 1366509929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY16157) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY16157) |
| 103TM1800X Psychologist Mental Retardation & Developmental Disabilities (Licence: CA PSY16157) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2013-06-11 |