| NPI | 1053318360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS-006224-L) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY-11983) |
| Enumeration Date | 2005-06-30 |
| Last Update Date | 2016-10-05 |