| NPI | 1982052635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 33067) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: OR 3389) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2022-03-01 |