| 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 |