| NPI | 1235872847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY33286) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 33286) |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2024-05-31 |