NPI | 1376847293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy13558) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA psy13558) |
Enumeration Date | 2011-01-06 |
Last Update Date | 2011-01-06 |