| NPI | 1174691018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 22722) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 6161) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2009-06-08 |