| NPI | 1427398486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY18344) |
| Additional Taxonomies | 251K00000X Public Health or Welfare (Licence: CA PSY18344) |
| Enumeration Date | 2013-02-27 |
| Last Update Date | 2013-02-27 |