| NPI | 1417960592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY35292) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AL 1482) |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2024-10-21 |