| NPI | 1225282015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY5119) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY5119) |
| Enumeration Date | 2008-11-06 |
| Last Update Date | 2008-11-06 |