| NPI | 1306087176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 18054) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: CA PSY 18054) |
| Enumeration Date | 2009-03-09 |
| Last Update Date | 2009-03-09 |