| NPI | 1689906406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 28612) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY28612) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2022-07-21 |