NPI | 1578846473 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 25093) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 25093) |
Enumeration Date | 2011-09-27 |
Last Update Date | 2024-09-16 |