| NPI | 1740687508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy29320) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2023-03-03 |