| NPI | 1346558285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY14179) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: AL 1933) |
| 103TC0700X Psychologist Clinical (Licence: AL 1933) | |
| 103TC0700X Psychologist Clinical (Licence: CA PSY14179) | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2024-08-15 |