| NPI | 1477682961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY17853) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 17853) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2021-07-29 |