| NPI | 1528122488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY25682) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: DC PSY100074) |
| Enumeration Date | 2006-12-21 |
| Last Update Date | 2014-12-18 |