| NPI | 1033268149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MI 002718) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA CP11369) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2017-02-15 |