| NPI | 1225235732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy25029) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY25029) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2024-06-05 |