| NPI | 1487979753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY9414) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY9414) |
| Enumeration Date | 2010-03-30 |
| Last Update Date | 2011-04-15 |