| NPI | 1821035585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY00011468) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY11468) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY11468) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2012-10-23 |