| NPI | 1922030253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY13383) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY13383) |
| 103TA0700X Psychologist Adult Development & Aging | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY13383) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2016-07-27 |