| NPI | 1700054467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 18019) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA 18019) |
| Enumeration Date | 2008-02-15 |
| Last Update Date | 2016-05-24 |