| NPI | 1245660281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 21994) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 1236) |
| 103TC0700X Psychologist, Clinical (Licence: AZ 3951) | |
| Enumeration Date | 2013-11-12 |
| Last Update Date | 2013-11-12 |