| NPI | 1568610913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 21474) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY21474) |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810003812) | |
| Enumeration Date | 2008-08-28 |
| Last Update Date | 2020-07-09 |