| NPI | 1477658680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY19358) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 19358) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2024-04-05 |