| NPI | 1508031592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA psy21884) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA Psy21884) |
| 103TC0700X Psychologist, Clinical (Licence: OR 3152) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2024-02-08 |