| NPI | 1427302454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY23431) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities |
| 103TF0200X Psychologist, Forensic | |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2017-03-21 |