| NPI | 1821103524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY24234) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810002964) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY24234) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY24234) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2014-06-09 |