| NPI | 1770781361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 103TC0700X) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: CA PSY15601) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA PSY15601) | |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2013-03-12 |