| NPI | 1891108031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 21838) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY 21838) |
| Enumeration Date | 2014-06-05 |
| Last Update Date | 2018-08-13 |