| NPI | 1447231246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 17817) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CO 2418) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2014-03-24 |