| NPI | 1487179925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY32640) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA LH61027314) |
| 246ZE0500X Specialist/Technologist, Other EEG (Licence: WA LH61027314) | |
| 246ZE0500X Specialist/Technologist, Other EEG (Licence: CA PSY32640) | |
| Enumeration Date | 2017-08-05 |
| Last Update Date | 2021-09-12 |