| NPI | 1750524427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY 10704) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 006074-1) |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2009-04-10 |