| NPI | 1205040961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA PSY 17557) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2016-12-12 |