| NPI | 1457756207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY10035) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NV PY0672) |
| Enumeration Date | 2014-10-22 |
| Last Update Date | 2014-10-22 |