| NPI | 1568595056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CA PSY14326) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY14326) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2024-11-19 |