| NPI | 1295912988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 4853) |
| Additional Taxonomies | 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY 4853) |
| 103TP0814X Psychologist, Psychoanalysis (Licence: CA PSY 4853) | |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2008-01-25 |