| NPI | 1174698989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 18109) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA 18109) |
| 103TF0200X Psychologist Forensic (Licence: CA 18109) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2012-12-06 |