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 |