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 |