| NPI | 1689093726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA psy9990) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA psy9990) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2016-11-15 |