| NPI | 1689706137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY7702) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MD 1506) |
| 103TC0700X Psychologist Clinical (Licence: CA PSY7702) | |
| 103TC0700X Psychologist Clinical (Licence: MD 1506) | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY7702) | |
| Enumeration Date | 2007-03-11 |
| Last Update Date | 2007-07-08 |