| NPI | 1811028111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA psy7817) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA psy7817) |
| 103TH0004X Psychologist, Health (Licence: CA PSY-7817) | |
| 103TH0100X Psychologist, Health Service (Licence: CA PSY-7817) | |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2018-07-26 |