| NPI | 1790791796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: CA LCS135532) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA LCS13553) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |