| NPI | 1578860938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TF0200X Psychologist, Forensic (Licence: CA psy 13000) |
| Additional Taxonomies | 103TF0200X Psychologist, Forensic (Licence: UT 4940521-2501) |
| Enumeration Date | 2011-02-22 |
| Last Update Date | 2011-02-22 |