| NPI | 1952858961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSB 94022509) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY30746) |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2021-03-09 |