| NPI | 1841229143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY18868) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY18868) |
| 103TH0100X Psychologist, Health Service (Licence: CA PSY18868) | |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2018-03-20 |