| NPI | 1790860674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY21973) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MN LP5150) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2016-11-30 |