| NPI | 1962759449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY30350) |
| Additional Taxonomies | 103TF0000X Psychologist Family (Licence: CA PSY30350) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2021-03-30 |