| NPI | 1194927855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CA PSY25375) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 25375) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY25375) | |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2024-04-27 |