| NPI | 1699858621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY15804) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CO PSY 2379) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2010-11-30 |