| NPI | 1144405572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY21628) |
| Additional Taxonomies | 103TE1100X Psychologist Exercise & Sports (Licence: CA PSY21628) |
| 103TH0004X Psychologist Health (Licence: CA PSY21628) | |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2013-12-06 |