| 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 |