| NPI | 1134341886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 24128) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: UT 116998-2501) |
| 103TC0700X Psychologist, Clinical (Licence: CA 24128) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: UT 11698-2501) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2020-10-13 |