| NPI | 1205068780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY28191) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 3171) |
| Enumeration Date | 2009-08-17 |
| Last Update Date | 2020-02-06 |