| NPI | 1780709436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY24863) |
| Additional Taxonomies | 103T00000X Psychologist |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TF0200X Psychologist Forensic | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2023-07-19 |