| NPI | 1225175060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 18306) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 765) |
| 103TF0200X Psychologist, Forensic (Licence: CA 18306) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-08 |