| NPI | 1356531040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 20699) |
| Additional Taxonomies | 103TH0004X Psychologist, Health |
| Enumeration Date | 2007-07-28 |
| Last Update Date | 2013-09-20 |