| NPI | 1609225523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CO PSY 0001224) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY13824) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2016-06-10 |