| NPI | 1396807053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY4256) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 4256) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2020-02-24 |