| NPI | 1982885158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY31384) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY31384) |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2019-10-31 |