| NPI | 1518063171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY13468) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY13468) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2011-10-06 |