| NPI | 1235670134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY28488) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY28488) |
| 103TH0004X Psychologist Health (Licence: CA PSY28488) | |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2017-03-13 |