| NPI | 1124162557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY12716) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| 103T00000X Psychologist (Licence: CA PSY12716) | |
| Enumeration Date | 2007-02-18 |
| Last Update Date | 2012-11-05 |