| NPI | 1386908580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY27178) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY27178) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY 27178) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2024-04-29 |