| NPI | 1326557976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY35648) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO 0002287) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2025-02-10 |