| NPI | 1346271079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY7204) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY7204) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2012-11-26 |