| NPI | 1285091124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA PSY18551) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY18551) |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2019-03-22 |