| NPI | 1306054549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY23093) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NV PY0642) |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY23093) | |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2023-02-16 |