| NPI | 1902267008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY29830) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic |
| Enumeration Date | 2016-03-16 |
| Last Update Date | 2024-01-12 |