| NPI | 1396063053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY30059) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 30059) |
| 103TC0700X Psychologist, Clinical (Licence: OR 2943) | |
| 103G00000X Clinical Neuropsychologist (Licence: OR 2943) | |
| 103TC0700X Psychologist, Clinical (Licence: MI 6301016179) | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2023-09-25 |