| NPI | 1730400029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist Health Service (Licence: CA 27997) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic |
| Enumeration Date | 2010-06-21 |
| Last Update Date | 2020-12-28 |