| NPI | 1992959761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NC 4561) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA PSY 22288) |
| 103T00000X Psychologist (Licence: NC 4561) | |
| 103T00000X Psychologist (Licence: CA PSY 22288) | |
| 103TC0700X Psychologist, Clinical (Licence: NC 4561) | |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY22288) | |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2019-12-16 |