| NPI | 1326272816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CO PSY.0004112) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY25921) |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2016-02-15 |