| NPI | 1265535660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY114970) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 0PL114970) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2023-08-30 |