| NPI | 1649371212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY5938) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA OPL59380) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2012-03-29 |