| NPI | 1700226289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: CA PSY28114) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 28114) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2023-12-06 |