NPI | 1497737738 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY 17035) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY 17035) |
Enumeration Date | 2005-11-14 |
Last Update Date | 2007-07-08 |