| NPI | 1639673940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WI 3552-57) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY29541) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2018-03-21 |