| NPI | 1609188671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY28215) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY28215) |
| Enumeration Date | 2010-07-07 |
| Last Update Date | 2024-07-23 |