| NPI | 1245508084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 23939) |
| Additional Taxonomies | 103TF0200X Psychologist Forensic (Licence: CA 23939) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2011-12-08 |