| NPI | 1619227006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY26278) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY26278) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY26278) | |
| Enumeration Date | 2012-09-13 |
| Last Update Date | 2014-03-24 |