| NPI | 1053547711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY12830) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY12830) |
| 103TF0200X Psychologist, Forensic (Licence: CA psy12830) | |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2009-06-08 |