| NPI | 1871576322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 16872) |
| Additional Taxonomies | 103TR0400X Psychologist Rehabilitation (Licence: CA 16872) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2007-07-08 |