| NPI | 1447589569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NM 1108) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: CA PSY28177) |
| Enumeration Date | 2009-12-19 |
| Last Update Date | 2016-08-02 |