| NPI | 1306629399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY33091) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| Enumeration Date | 2023-08-15 |
| Last Update Date | 2023-08-15 |