| NPI | 1508388836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY14510) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY14510) |
| 103TC0700X Psychologist, Clinical (Licence: CA PSY14510) | |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2022-07-21 |