| NPI | 1871802629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY26134) |
| Additional Taxonomies | 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: CA PSY26134) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2014-10-09 |