| NPI | 1922561489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 16768) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 16768) |
| Enumeration Date | 2019-04-11 |
| Last Update Date | 2019-04-11 |