| NPI | 1164429312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: KY 566) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY3523) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2007-07-08 |