| NPI | 1568593523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 22168) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY22168) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2016-11-16 |