| NPI | 1861696635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: CA PSY15992) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA PSY15992) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2025-01-30 |