| NPI | 1801007380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY15596) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: CA PSY15596) |
| 103TH0004X Psychologist Health (Licence: CA PSY15596) | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2023-11-06 |