| NPI | 1336207471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY21605) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-05-26 |