| NPI | 1700165602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY25555) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSB36547) |
| Enumeration Date | 2011-08-09 |
| Last Update Date | 2018-02-02 |