| NPI | 1033431788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 090846) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY26342) |
| 103TC0700X Psychologist, Clinical (Licence: IL 071.009483) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: IA 090846) | |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2018-07-19 |