| NPI | 1043463714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY22614) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO LP3321) |
| 103TC0700X Psychologist Clinical (Licence: CO 9724) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2018-08-15 |