| NPI | 1740408251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY5981) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY5981) |
| 103TH0100X Psychologist, Health Service (Licence: CA PSY5981) | |
| Enumeration Date | 2007-04-22 |
| Last Update Date | 2010-10-29 |