| NPI | 1669817607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY31070) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MD 05438) |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2019-09-04 |