| NPI | 1184957664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IA 099628) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 24861) |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2023-10-27 |