| NPI | 1396894242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 21029) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NE 600) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2007-07-08 |