| NPI | 1376524645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 31436) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR 1390) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2020-01-28 |