| NPI | 1952394033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA PSY13833) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY13833) |
| 103TF0200X Psychologist Forensic (Licence: CA PSY13833) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2009-04-28 |