| NPI | 1760976070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY33543) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2023-03-07 |