| NPI | 1902219850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY26386) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 26386) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2021-06-24 |