| NPI | 1902095185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: OR 2023) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY22117) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2023-04-25 |