| NPI | 1659478113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY19880) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY1988) |
| Enumeration Date | 2006-09-19 |
| Last Update Date | 2020-02-03 |