| NPI | 1174503403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 20877) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY7003) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2014-01-27 |