| NPI | 1124236153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY6175) |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: CA PSY6175) |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY6175) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-07-08 |