| NPI | 1578683926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY15734) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI 1638) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2019-12-16 |