| NPI | 1417961087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 23191) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: PA PS008354L) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2011-10-21 |