| NPI | 1275615866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: NC 3352) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY 17570) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2008-01-14 |