| NPI | 1720095185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA CP8510) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ID PSY202312) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2017-02-15 |