| NPI | 1093711749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY11922) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY11922) |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY11922) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2020-02-10 |