| NPI | 1245251073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY10800) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA PSY10800) |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY10800) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-09 |