| NPI | 1265587190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI PSY 1067) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY15312) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2014-08-06 |