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 |