| NPI | 1134182058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 20658) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA psy20658) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2020-04-09 |