| NPI | 1568860229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 26905) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 531211) |
| Enumeration Date | 2014-12-12 |
| Last Update Date | 2015-01-15 |