| NPI | 1114203700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PSY0004303) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY27642) |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2016-04-05 |