| NPI | 1811993389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY 9194) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY 9194) |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY 9194) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2022-07-21 |