| NPI | 1245087204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 36078) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TF0000X Psychologist Family | |
| 103TH0100X Psychologist Health Service | |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2025-08-26 |