| NPI | 1588702930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 7756) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY7756) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2018-02-15 |