| NPI | 1992022842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY23631) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103T00000X Psychologist | |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2019-11-19 |