| NPI | 1073950267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY13656) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103TE1100X Psychologist, Exercise & Sports | |
| 103TP0814X Psychologist, Psychoanalysis | |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2016-03-17 |