| NPI | 1851498737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY14872) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AK 150137) |
| 103G00000X Clinical Neuropsychologist (Licence: AK 150137) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-11-06 |