| NPI | 1962783464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY31410) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA RPS 2012468) |
| 103TC0700X Psychologist Clinical (Licence: VA 0810005615) | |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2020-01-28 |