| NPI | 1255789913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY31629) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2022-12-07 |