NPI | 1689725574 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY5107) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: HI 711) |
Enumeration Date | 2007-01-16 |
Last Update Date | 2013-03-28 |