| NPI | 1528389251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 28126) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TH0004X Psychologist, Health | |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2020-06-01 |