| NPI | 1578502084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NC 3288) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY9236) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2011-05-31 |