| NPI | 1760849178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY7038) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY7038) |
| 103TE1100X Psychologist, Exercise & Sports (Licence: CA PSY7038) | |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2016-03-01 |