| NPI | 1750483467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 16519) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA PSY16519) |
| Enumeration Date | 2006-09-02 |
| Last Update Date | 2020-05-30 |