| NPI | 1710109830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY10588) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: CA PSY10588) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY10588) | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY10588) | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY10588) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2007-07-08 |