| NPI | 1740337914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY12604) |
| Additional Taxonomies | 103TR0400X Psychologist Rehabilitation (Licence: CA PSY12604) |
| 103TC1900X Psychologist Counseling (Licence: CA PSY12604) | |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2022-02-11 |