| NPI | 1427310937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY28640) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY28640) |
| 103TC0700X Psychologist Clinical (Licence: CA 28640) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2021-04-02 |