| NPI | 1740736404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 34453) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MD 061272) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2023-10-23 |