| NPI | 1609900125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY12704) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 1874) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2007-07-08 |