| NPI | 1972027852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 30305) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 3023) |
| 103T00000X Psychologist | |
| Enumeration Date | 2017-08-01 |
| Last Update Date | 2021-12-29 |