NPI | 1619726742 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY34945) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
Enumeration Date | 2024-05-13 |
Last Update Date | 2024-08-02 |