| NPI | 1679611099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY17314) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: KY 695) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2007-07-08 |