| NPI | 1558317636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OR 3422) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY19133) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2026-03-03 |