| NPI | 1760770192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28115) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 28115) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2024-01-10 |