| NPI | 1134454663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY23051) |
| Additional Taxonomies | 103TH0004X Psychologist, Health |
| 103TR0400X Psychologist, Rehabilitation | |
| Enumeration Date | 2009-10-16 |
| Last Update Date | 2009-10-16 |