NPI | 1568994101 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28970) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY28970) |
Enumeration Date | 2017-04-03 |
Last Update Date | 2024-07-23 |