| NPI | 1386513851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY36156) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY36156) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY36156) | |
| Enumeration Date | 2025-11-03 |
| Last Update Date | 2025-11-03 |