| NPI | 1578990248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY32940) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: GA PSY004776) |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2024-08-09 |