| NPI | 1447512744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY27060) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA 27060) |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2021-04-08 |