| NPI | 1538710207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 33538) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 11421644-2504) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2022-08-23 |