NPI | 1528194032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY19882) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY19882) |
103TR0400X Psychologist, Rehabilitation (Licence: CA PSY19882) | |
Enumeration Date | 2007-02-26 |
Last Update Date | 2007-07-16 |