| NPI | 1053540054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 13630) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: CA PSY 13630) |
| Enumeration Date | 2009-07-10 |
| Last Update Date | 2009-07-10 |