| NPI | 1487673596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TH0100X Psychologist, Health Service (Licence: CA 20328) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: CO 1565) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |