| NPI | 1427119916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 6216) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY6216) |
| 103TF0200X Psychologist, Forensic (Licence: CA PSY6216) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |