| NPI | 1700988540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MO PYR0533) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY9294) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2018-12-12 |