| NPI | 1043479280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY27133) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 27133) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2025-06-10 |