| NPI | 1588833180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 14799) |
| Additional Taxonomies | 103TP2701X Psychologist, Group Psychotherapy (Licence: CA 14799) |
| Enumeration Date | 2008-02-27 |
| Last Update Date | 2015-04-15 |