| NPI | 1154763936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 31180) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA 31180) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2020-09-24 |