| NPI | 1063855336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY25675) |
| Additional Taxonomies | 103TH0004X Psychologist Health |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2021-12-21 |