| NPI | 1508855701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY8361) |
| Additional Taxonomies | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA PSY8361) |
| Enumeration Date | 2005-10-19 |
| Last Update Date | 2007-07-08 |