| NPI | 1790095248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY18734) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY18734) |
| 103TH0004X Psychologist, Health (Licence: CA PSY18734) | |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2018-05-15 |