| NPI | 1154852655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P2900X Psychiatry & Neurology, Pain Medicine (Licence: CA PSY31480) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY31480) |
| 103TC0700X Psychologist, Clinical (Licence: TX 37564) | |
| Enumeration Date | 2017-03-25 |
| Last Update Date | 2026-03-17 |