| NPI | 1417154394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 24419) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: CA 24419) |
| 103TC0700X Psychologist Clinical (Licence: CA 24419) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: CA 24419) | |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2023-02-13 |