| NPI | 1679683007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 20362) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA psy20362) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-12-05 |