| NPI | 1922115732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY14483) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY14483) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2015-02-06 |