| NPI | 1215239603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY30605) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: VA 0810004318) |
| Enumeration Date | 2010-11-17 |
| Last Update Date | 2021-08-26 |