| NPI | 1891786117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 2019) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY11246) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2021-10-06 |