| NPI | 1740331610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 14542) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY 14542) |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY 14542) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2013-08-08 |