| NPI | 1336295500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY16608) |
| Additional Taxonomies | 103TA0700X Psychologist Adult Development & Aging (Licence: CA PSY16608) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY16608) | |
| 103TA0700X Psychologist Adult Development & Aging | |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2011-02-22 |