| NPI | 1821468604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 31637) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSB94022429) |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2021-07-08 |