| NPI | 1700102977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 26445) |
| Additional Taxonomies | 103TC1900X Psychologist Counseling (Licence: CA PSY 26445) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2014-07-08 |