| NPI | 1740320852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY14238) |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) (Licence: CA PSY14238) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY14238) | |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY14238) | |
| 103TH0100X Psychologist, Health Service (Licence: CA PSY14238) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY14238) | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2011-11-01 |