| NPI | 1801908694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 23309) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 0857) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2013-04-11 |