| NPI | 1508897836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY20225) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: NY 004467) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2015-09-21 |