| NPI | 1124309018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: AR 13-05AP-PL) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY24284) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2013-09-10 |