| NPI | 1649404096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: LA 1167) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY22677) |
| Enumeration Date | 2009-05-13 |
| Last Update Date | 2015-11-03 |