NPI | 1407951965 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY7837) |
Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY7837) |
Enumeration Date | 2006-09-13 |
Last Update Date | 2007-07-08 |