| NPI | 1104089192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 11829) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY11829) |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2012-10-12 |