| NPI | 1245465335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 13898) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY 13898) |
| 103TB0200X Psychologist Cognitive & Behavioral (Licence: CA PSY 13898) | |
| 103TE1100X Psychologist Exercise & Sports (Licence: CA PSY 13898) | |
| Enumeration Date | 2009-05-19 |
| Last Update Date | 2009-05-19 |