| NPI | 1912326117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY27618) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VT 048.0134290) |
| 103T00000X Psychologist (Licence: FL PY8118) | |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2022-08-04 |