| NPI | 1194097048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 24782) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY24782) |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2012-02-23 |