| NPI | 1730476763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY24113) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY24113) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2022-12-29 |