| NPI | 1750670030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY23882) |
| Additional Taxonomies | 103TP2701X Psychologist Group Psychotherapy (Licence: CA PSY23882) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2011-04-07 |