| NPI | 1316017221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25469) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CA PSY25469) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2013-02-20 |