| NPI | 1790904233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: CA Psy 15357) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 15357) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-08 |