| NPI | 1558558569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 27417) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: CA 27417) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2018-12-12 |