| NPI | 1730386269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA 21388) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: HI 1124) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2010-09-16 |