| NPI | 1407290752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY10217) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY10217) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY10217) | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY10217) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2013-04-17 |