| NPI | 1609445444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 32064) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 32064) |
| 103T00000X Psychologist (Licence: CA 32064) | |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2022-10-07 |