| NPI | 1083646673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 3834) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: CA PSY 3834) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2007-07-08 |