| NPI | 1053513432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TH0004X Psychologist, Health (Licence: CA PSY4685) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC126) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2013-07-23 |