| NPI | 1003819566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY14926) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: CA PSY14926) |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2015-05-04 |