| NPI | 1366641490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 22834) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI psy1007) |
| Enumeration Date | 2007-07-18 |
| Last Update Date | 2014-05-01 |