| NPI | 1326298415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: OR 2539) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY 27493) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2017-05-25 |