| NPI | 1356401061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY18575) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: TX 34084) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2010-09-22 |