NPI | 1710150685 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY 7564) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 7564) |
Enumeration Date | 2008-04-10 |
Last Update Date | 2008-04-10 |