| NPI | 1114023603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 11496) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: CA PSY 11496) |
| 103T00000X Psychologist (Licence: CA PSY 11496) | |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2010-09-21 |