| NPI | 1215205547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA Psy16088) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: FL LPY11) |
| Enumeration Date | 2011-12-01 |
| Last Update Date | 2024-07-18 |