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 |