| NPI | 1629059092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA psy10274) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA psy10274) |
| 103TC0700X Psychologist, Clinical (Licence: CA psy10274) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA psy10274) | |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2007-07-08 |