| NPI | 1730274713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: SC 1210) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: CA RPS2002005) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2013-09-22 |