| NPI | 1255683199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 28794) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY28794) |
| Enumeration Date | 2012-10-02 |
| Last Update Date | 2018-08-30 |