| NPI | 1295189769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: CA PSY5757) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY5757) |
| 103T00000X Psychologist (Licence: CA PSY5757) | |
| 103TH0100X Psychologist, Health Service (Licence: CA PSY5757) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2024-09-07 |