| NPI | 1750722922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA psy23293) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA psy23293) |
| Enumeration Date | 2013-07-16 |
| Last Update Date | 2017-01-24 |