| NPI | 1417930009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist Health (Licence: CA PSY 13735) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY13735) |
| 103TC0700X Psychologist Clinical (Licence: CA PSY13735) | |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2009-11-23 |