| NPI | 1710155171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY14795) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA psy14795) |
| Enumeration Date | 2008-02-19 |
| Last Update Date | 2012-01-05 |