| NPI | 1669779617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY10720) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY10720) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA PSY10720) | |
| Enumeration Date | 2011-02-25 |
| Last Update Date | 2011-02-25 |