| NPI | 1710253760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY 12757) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: NY 018742-1) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2012-03-23 |