| NPI | 1720377559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25299) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CA PSY25299) |
| 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY25299) | |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2021-11-30 |