| NPI | 1417189846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA Psy 21055) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MS Psy 46754) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2009-08-18 |