| NPI | 1215691092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 34724) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic |
| Enumeration Date | 2021-10-27 |
| Last Update Date | 2023-12-25 |