| NPI | 1750791307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY31225) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: IA 072303) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2026-08-12 |