| NPI | 1184968422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 30616) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 30616) |
| Enumeration Date | 2012-11-26 |
| Last Update Date | 2021-07-23 |