| NPI | 1821363896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY23794) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 23794) |
| Enumeration Date | 2012-03-09 |
| Last Update Date | 2015-02-17 |