| NPI | 1558558676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY26787) |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) |
| 251S00000X (Licence: CA PSY 26787) | |
| 282N00000X General Acute Care Hospital (Licence: CA PSY 26787) | |
| 283Q00000X Psychiatric Hospital | |
| Enumeration Date | 2007-10-02 |
| Last Update Date | 2020-08-21 |