| NPI | 1568797611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 23155) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: OR Limited Permit 160) |
| 103TC0700X Psychologist, Clinical (Licence: OR 2066) | |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2017-03-22 |