| NPI | 1528179470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 9684) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY 621) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2012-05-01 |