| NPI | 1144251471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA PY00003607) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY19706) |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY19706) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2019-07-16 |