| NPI | 1336699248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY29040) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WI 3397-57) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2018-04-02 |