| NPI | 1184644163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 24617) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OH 5613) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2012-03-06 |