| NPI | 1588916738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY12813) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY12813) |
| Enumeration Date | 2012-10-12 |
| Last Update Date | 2023-10-13 |