| NPI | 1720020407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY19522) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: HI PSY866) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2013-11-04 |