| NPI | 1184086159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 36897) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CA 36897) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2026-08-18 |