| NPI | 1811107907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 21463) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA 21463) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2023-11-03 |