| NPI | 1669612727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy27684) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: GA PSY004177) |
| Enumeration Date | 2009-03-03 |
| Last Update Date | 2021-03-01 |