| NPI | 1679686083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 27046) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA 7114) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2020-05-22 |