| NPI | 1356560668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 26432) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY26432) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2024-05-07 |