| NPI | 1124260948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 2168) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY22185) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2022-05-23 |