| NPI | 1770005027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: CA 32283) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 32283) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2023-11-14 |