| NPI | 1881295483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 33494) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: TN 3773) |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2022-08-25 |