| NPI | 1538346820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY22548) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60443812) |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2015-02-02 |