| NPI | 1356577415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: HI 1352) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY17965) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2015-06-23 |