| NPI | 1205887767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY35272) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: AZ 3768) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-09-30 |