| NPI | 1194093039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY11764) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: MA 8969) |
| 103TF0200X Psychologist Forensic (Licence: NY 010201) | |
| 103TF0200X Psychologist Forensic (Licence: CA PSY11764) | |
| Enumeration Date | 2011-12-07 |
| Last Update Date | 2015-09-15 |