| NPI | 1982712386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY10139) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY606) |
| 103G00000X Clinical Neuropsychologist (Licence: CA PSY10139) | |
| 103TC0700X Psychologist, Clinical (Licence: AZ 3274) | |
| Enumeration Date | 2006-08-26 |
| Last Update Date | 2024-08-08 |