| NPI | 1285832410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY22166) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA RPS2007006) |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2016-07-26 |