| NPI | 1154414936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0700X Psychologist, Adult Development & Aging (Licence: CA PSY9166) |
| Additional Taxonomies | 103TR0400X Psychologist, Rehabilitation (Licence: CA PSY 9166) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2013-06-18 |