| NPI | 1346254786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 20809) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NH 1061) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2010-10-20 |