| NPI | 1518138049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY26041) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: UT 67249902501) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY26041) | |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2014-11-03 |