| NPI | 1114196987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 28796) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 2235) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2016-12-20 |