| NPI | 1033601075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 34575) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: IA 121196) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2023-10-02 |