| NPI | 1124539697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY29290) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CA PSY29290) |
| Enumeration Date | 2017-10-23 |
| Last Update Date | 2020-10-09 |